Gout

Gout

Gout is one of the most painful forms of arthritis caused by long-term purine metabolic disturbance. It is clinically characterized by high levels of uric acid in the body (hyperuricemia), repeated attacks of acute arthritis, chronic arthritis with deformity of joints, formation and sedimentation of uric acid deposits (trophi) under the skin, and pathogenic change of the kidney.

Gout can be categorized into two main causes: primary gout is caused by congenital purine metabolic disturbance, and secondary gout is due to hyperuricemia, which is induced by other diseases or drugs such as diuretics. The disease can occur in people of all ages, but most predominantly in people of age 30 to 40. Most patients (around 95%) diagnosed with gout are male and usually have a family history of gout.

Western medicine regards gout as a disease caused by a high buildup of uric acid in the blood, usually caused by high intakes of food containing purines and malfunction of the kidneys in getting rid of excess uric acid in the body through urination. Excess uric acid can accumulate in the body and form hard crystals in joints, leading to acute and chronic pain and swelling in the joints. Depending on the patient’s situation, doctors can prescribe drugs ranging from nonsteroidal anti-inflammatory drugs (NSAIDS) to colchicines to relieve gout symptoms, which include but not limited to recurrence of redness, swelling, burning pain and stiffness in the joints. Research is still underway to discover the most effective treatment methods for gout that can reduce the chance of recurrence and most potent medicines to safely lower the uric acid level in the blood without causing side-effects in patients who take them.

In TCM, gout symptoms are categorized as “bi-syndrome”, and gout is considered to be externally caused by the invasion of exogenous pathogenic wind, cold and damp heat into the body, and internally caused by the deficiency in qi, overstress, or exposure to wind while sweating, thereby weakening the healthy qi in the body to fail to protect it from exogenous pathogenic factors. This will lead to a blockage of the meridians and stagnation of qi and blood. In the long term, blood stasis and phlegm stagnation can appear, causing visceral bi-syndrome as characterized by gout symptoms. Treatment of gout seeks to remove the pathological factors of the disease, including dampness, phlegm and blood stasis, and support healthy qi. The gout syndromes can be differentiated as follows:

(i) Obstruction of Damp Heat in the Meridians

Main symptoms are redness, swelling, and burning pain in the joints that can be temporarily relieved by using ice packs, or fever with constipation, dark yellow urine, yellow and greasy tongue coating, and wiry and rapid or smooth and rapid pulse. For this type of syndrome, it is best to treat with removing heat and dampness, as well as obstruction in the collaterals as the main objective.

(ii) Invasion of the Collaterals by Cold and Dampness

Main symptoms are the stiffness and deformity of the joints with limited flexibility, and can be accompanied by darkish red skin, aversion to cold and cold limbs, darkish tongue with ecchymosis, thin and white tongue coating, and deep and thin pulse. For this type of syndrome, it is best to bring heat to the meridians to eliminate the cold, dampness so as to activate the collaterals.

(iii) Phlegm Stagnation Blending with Blood Stasis

Main symptoms are the appearances of normal-colored, hard or ruptured nodules under the skin, and can be accompanied by darkish tongue with occasional ecchymosis, thin and white tongue coating, and deep and smooth pulse. For this type of syndrome, it is best to resolve the phlegm by eliminating the stagnation and activate blood circulation to dissipate the stasis.

(iv) Retained Damp Heat in the Urinary Bladder

Main symptoms are the presence of sandy stones in the urine, and difficult, frequent and urgent urination. They can be accompanied by urethral pain and colicky pain in the loins and abdomen and even blood in the urine. A red tongue with yellow coating and rapid pulse can be observed. For this type of syndrome, it is best to clear away the excess heat by promoting diuresis, relieving the painful urination and expel the stones.

(v) Deficiency of Spleen Yang and Kidney Yang

Main symptoms are the shortness of breath, fatigue, loss of appetite, nausea, vomiting, abdominal flatulence, loose stools, and sore and weak loins and knees, and can be accompanied by aversion to cold, cold limbs, edema of the face and lower limbs, pale complexion, pale swollen tongue with white and thin coating, and deep, thin and faint pulse. For this type of syndrome, it is best to reinvigorate the spleen by replenishing qi, nourishing the kidney and increase the kidney yang.

Please feel free to consult one of our health practitioners or other Chinese medicine health professionals in treating your gout syndromes. It is recommended for gout patients to drink plenty of water and maintain a healthy and balanced diet. In addition, it is best to avoid foods containing high levels of purine, as well as alcohol and any medication such as diuretics and aspirin that may cause a surge in uric acid level in the body.